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Qi is, generally speaking, caused by this condition. The *Jingui Fang* records: Cold hernia causing abdominal pain, cold limbs, and numbness in the hands and feet; if accompanied by body pain, and unresponsive to moxibustion, acupuncture, and various medications, it should be treated with Didang Wutou Guizhi Tang (Cinnamon Twig and Aconite Decoction). Take one portion of Wutou (Aconiti Radix), decoct it with two sheng of honey until reduced by half, remove the dregs, mix with five he of Guizhi Tang (Cinnamon Twig Decoction) to obtain one sheng of liquid. Initially administer two he; if no effect, administer three he; if still no effect, increase to five he. If the patient feels a sensation, resembling drunkenness, and vomits, it indicates the medicine has struck the disease. Haicang (Zhang Yuansu) used Fuzi Jianzhong Tang (Aconite Decoction to Establish the Middle) added with honey to treat hernia, which is an application of this method. Abdominal pain with a wiry and tight pulse: wiry indicates obstructed Wei Qi (Defensive Qi), leading to aversion to cold; tight indicates loss of appetite. The interplay of wiry and tight pulses constitutes cold hernia. Cold hernia manifests as periumbilical pain; upon onset, spontaneous sweating and cold extremities occur, with a deep and wiry pulse, treated with Da Wutou Jian (Great Aconite Decoction). *Yanyi* states: Halobaba (Trigonellae Semen) is very effective for Bladder Qi when combined with Huixiang (Foeniculi Fructus) and Taoren (Persicae Semen), as recorded in *Benjing*. I once combined equal parts of Taoren (wheat bran-fried) and Halobaba, making half into wine-paste pills and half into powder. Each dose was 50-70 pills, taken on an empty stomach before meals with salted liquor. The powder was mixed with hot rice water, alternating with pills, taking 1-2 doses on an empty stomach for efficacy. *Baojian* contains Halobaba Wan (Pill).

Danxi's formula for internal stagnation of damp-heat decoction: Zhishi (Immature Bitter Orange, fried 9 grains), Taoren (Peach Kernel, fried 14 grains), Shanzhiren (Gardeniae Semen, fried 9 grains), Wu Zhu Yu (Evodiae Fructus, fried 7 grains), Shanzha (Crataegi Fructus, fried 4 grains), Shengjiang (Fresh Ginger, finger-sized). These six ingredients are ground finely in a mortar. Take one zhong of flowing water, put in a bottle, and decoct until slightly boiling. Drink with the dregs. For hernia dominated by dampness, add Litchi He (Litchi Seed). For severe pain, add Yan Chao Dachuan Xiang (Salt-fried Anise Fruit) 2 qian. For tender pain points, add a small amount of Bo Gui (Thin Cinnamon Twig).
Pill Formula: Shanzhi (Gardeniae Fructus, 2 liang fried), Shanzha (Crataegi Fructus, 4 liang fried), Zhishi (Immature Bitter Orange, fried), Huixiang (Foeniculi Fructus, 2 liang fried), Chaihu (Bupleuri Radix), Mudanpi (Moutan Cortex), Bajiao Huixiang (Star Anise, 1 liang fried), Taoren (Peach Kernel, fried), Zhuyu (Evodiae Fructus, 0.5 liang fried). Grind into powder, make pills with wine paste. Take 50-60 pills on an empty stomach with salt water. When Damp-Heat affects the Yangming channel and transmits to the Large Intestine, causing fever, aversion to cold, and unbearable stifling pain in the lower abdomen extending to the pubic region, use Fried Gardeniae Semen, Fried Peach Kernels, Fried Immature Bitter Orange, and Crataegi Fructus in equal parts. Grind finely, add 0.5 he of fresh ginger juice, decoct with one zhong of water until boiling, and take hot. Another prescription adds Evodiae Fructus.

Combining Cold and Heat Treatments: *Ling Shu* states: Heat in the Stomach and Cold in the Intestines cause rapid hunger and lower abdominal distending pain. Danxi says: My view is that using equal parts of Chuan Wutou (Chuanwu) and Shanzhiren (Gardeniae Semen) as a decoction yields rapid results. Later, I modified this formula according to symptoms and constitution, achieving consistent efficacy.
Essentially, Chuan Wutou treats external constriction of Cold, while Shanzhiren treats internal stagnation of Heat. It is also stated: For all hernia pain sites, if pressing does not elicit pain, it belongs to Deficiency. Use equal parts of Guizhi (Cinnamomi Ramulus), fried Shanzhi (Gardeniae Fructus), and Chuan Wutou (Aconiti Radix Preparata), grind into fine powder, make pills with fresh ginger juice, size of paulownia seeds. Take 30-40 pills on an empty stomach with plain water. Luo Qianfu states: Yin Hernia involves the Foot Jueyin Liver Channel, which circles the genitalia and reaches the lower abdomen. Pain may arise from Kidney Deficiency with depletion of Cold Water; treatment should drain pathogenic factors and tonify the Liver, using Jili Tang (Tribuli Decoction).

Tonification Case: Danxi states: Hernia can occur with concurrent deficiency, characterized by a pulse that is not deeply wiry and tight, but rather large, hollow, and weak. The pain is mild, felt only as heaviness and traction. Treatment should prioritize Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) as sovereign drugs, assisted by Dao Drugs (Guiding Medicines). Dao Drugs refer to substances like Taoren (Peach Kernel), Shanzha (Crataegi Fructus), Zhishi (Immature Bitter Orange), Shanzhiren (Gardeniae Semen), Zhuyu (Evodiae Fructus), Chuanlian (Meliosma Fructus), Yuanhuxsuo (Corydalis Rhizoma), Dingxiang (Caryophylli Flos), and Muxiang (Aucklandiae Radix). Haicang states: Ji Tiling took cooling agents for several days due to illness, resulting in severe pain in the umbilical and lower abdomen, nearly fatal. Given Jiang Fu (Ginger and Aconite) agents, he revived slightly but pain persisted. Increasing Shaoyao (Paeoniae Radix) in the original formula cured him. *Jingui Fang* records: For cold hernia with abdominal pain, or hypochondriac pain with interior tension, Danggui Shengjiang Yangrou Tang (Angelica Sinensis, Fresh Ginger, and Mutton Decoction) is indicated. *Yanyi* notes: Zhang Zhongjing treated cold hernia with Fresh Ginger and Mutton Decoction, with universal success. A woman gave birth in a cold month; cold qi entered the birth canal, causing fullness below the navel, intolerable to touch—this is cold hernia. The physician intended to use Didang Tang (Ephedra, Persica, Cornus, and Asarum Decoction) assuming blood stasis, which was incorrect. She was given Zhongjing's Mutton Decoction and recovered after two doses.

Liver Qi: Disease of the Foot Jueyin Liver Channel necessarily causes pain radiating from the lower abdomen to the hypochondrium. The Classics state: Return of Jueyin Qi causes hardness and fullness in the lower abdomen, interior urgency, and sudden pain, driven by Wind assisting excessive Liver Qi. Treatment should drain the Liver. Also: Excess Metal leads to people suffering hypochondriac and lower abdominal pain. Insufficiency of Wood leads to excessive Dryness, causing middle jiao cold, hypochondriac pain, and lower abdominal pain. Insufficiency of Earth leads to excessive Wind, causing abdominal pain; return Qi causes sudden chest/hypochondriac pain radiating to the lower abdomen, due to Dryness attacking deficient Liver. Treatment should tonify Liver and drain Metal. Also: Cold invading Jueyin channels causes blood stasis and vessel tension, leading to radiating pain between hypochondrium and lower abdomen. Liver disease causes hypochondriac pain radiating to the lower abdomen; treat via Foot Jueyin and Small Intestine channels. Evil invading Jueyin collaterals causes sudden hernia and acute pain; needle the junction of nail and flesh on the big toe (one point each side); men recover immediately, women shortly; treat left for right, right for left. To drain Liver, use Shanzhi (Gardeniae Fructus), Chuanxiong (Ligustici Rhizoma et Radix), Gui (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix). To tonify Liver, use Danggui (Angelicae Sinensis Radix), Shengjiang (Fresh Ginger), Yangrou (Mutton).

Small Intestine Qi: Small Intestine disease causes lower abdominal pain radiating to the testicles and connecting to the lumbar spine. The Classics state: Shaoyin channel heat below the heart causes frequent hunger and pain below the navel. Return of Shaoyin Qi causes internal warmth and lower abdominal cramping pain, due to Heat assisting Small Intestine excess. Treatment should drain the Small Intestine. Taiyang in the Lower Heaven with prevailing Cold, or Taiyang Return, both cause lower abdominal pain radiating to testicles, connecting to lumbar spine, and rushing up to the heart. Taicin ruling Heaven with severe Cold causes lower abdominal pain, due to Cold attacking deficient Small Intestine. Treatment should tonify Small Intestine and drain Cold. *Baojian* quotes *Zhizhen Dayao Lun*: Lower abdominal pain radiating to testicles, connecting to lumbar spine, rushing to heart, vomiting clear fluid, hiccups/belching, progressing to heart involvement with sadness and forgetfulness. *Jiayi Jing* states: Evil in the Small Intestine. Small Intestine disease causes lower abdominal pain radiating to lumbar spine, penetrating Liver/Lungs. When meridians are deficient, Wind-Cold enters. Pathogen rushes up to Liver/Lungs, cold disperses in chest, knots at navel, controls testicles, rises but does not descend, enters abdomen, and rushes to heart/chest due to meridian connections. Prescription: Fried Huixiang (Foeniculi Fructus), Lianshi (Loti Semen), Shizhuyu (Zanthoxyli Fructus), Chenpi (Citri Reticulatae Pericarpium), Malanhua (Iris Tectorii Flos, vinegar-fried, 1 liang each), Yuanhua (Genkwa Flos, vinegar-fried, 5 qian). Grind to powder, make pills with vinegar paste, size of paulownia seeds. Take 10-20 pills with warm wine. Another prescription: Yizhiren (Alpiniae Oxyphyllae Fructus), Pengzhu (Curcumae Rhizoma), 0.5 liang each; Huixiang, Shanzhuyu (Corni Fructus), Niuxi (Achyranthis Bidentatae Radix), Xuduan (Dipsaci Radix), Chuanxiong, Halobaba, Fangfeng (Saposhnikoviae Radix), Qianniu (Pharbitidis Semen, roasted), Gancao (Licorice Root), 2.5 qian each. Grind to powder. Take 3 qian, decoct with 1.2 zhong of water for 2-3 boils, take hot with dregs on empty stomach. Alternatively, mix with plain water (2 qian bi).

Bladder Qi: Bladder disease presents as lower abdominal swelling/pain and urinary retention. The Classics state: Taicin in the Lower Heaven causes lower abdominal swelling/pain and urinary retention, due to Dampness attacking deficient Bladder. Treatment should tonify Bladder and drain Damp-Earth evil. Also: Bladder disease causes unilateral lower abdominal swelling/pain; pressure induces urge to urinate without result; treat Weizhong (BL-40). Also: Lower abdominal swelling/pain with urinary retention, evil in Three Yang, treat Foot Taiyang major collateral (Weiyang BL-34). Xu Xueshi states: In Yuecheng, Song Xunfu, Magistrate of She, suffered unbearable Bladder Qi pain. Harsh medicines worsened it; urinary retention for three days, lower abdominal distension, chest oppression. His face was dark red/black, pulse large and forceful. I said excessive hot medicines caused Yin-Yang blockage and Qi obstruction. He held Sishen Dan (Four Spirit Pill) saying doctors advised continuing it. I warned death would follow. I prescribed Wuling San (Five-Ingredient Powder with Poria) divided into three doses, with scallion stalks, Huixiang, and salt, decocted in water. After three doses, he passed dark urine at midnight, waist relaxed, slept well. Pulse normalized next day. Continued with Sha Wan (Sand Pill) for recovery. Lou Quanshan treated Wife of Xie: lower abdominal pain, urinary retention. First moxa Sanyinjiao (SP-6). Then decoct Huixiang, Dingxiang, Qingpi, Binglang, Gui, Zhuyu, Yuanhuxsuo, Shanzha, Zhishi, with doubled Huangbai (Phellodendri Cortex), administered orally for cure.

Heart Hernia: Heart pulse slightly slippery indicates Heart Hernia. Heart pulse slippery and urgent indicates Heart Hernia. Emperor asked: Heart pulse is urgent, what disease? Qibo answered: Heart Hernia; there should be a palpable mass in the lower abdomen. Heart is a Yang organ, Small Intestine is its envoy, hence lower abdominal mass. Muxiang San (Wood-Aromatic Powder), Guang Zang Zhu San (Internal Organ Decoction).

[Hernia]: Testicular swelling, large as a measuring cup or bowl. Danxi states: For lower body Qi painless conditions, abstinence from sex and rich food is essential; medication merely prolongs life. Cangzhu (Atractylodis Rhizoma), Shenqu (Medicated Leaven), Baizhu (Atractylodis Rhizoma - *Note: Text likely implies Baizhi Angelicae Dahuricae Radix based on context of "Baizhu" typo or distinct herb*), Shanzha, Chuanxiong, Zhishi, Banxia (Pinelliae Rhizoma) are key herbs. People despise these cheap herbs, neglect abstinence, harming themselves. Herbs must be adjusted by season and Five Elements principles. Generally, Hernia is mostly Dampness. Cangzhu, Shenqu, Baizhi, Shanzha, Chuanxiong, Zhishi, Banxia, Nanxing (Arisaematis Rhizoma). Add Shanzhi (Gardeniae Fructus) 1 liang for Heat. Add Pomiao (Mirabilitum) 0.5 liang for hardness. Autumn/Winter add Wuzhuyu 2.5 qian, Shenqu paste pills. Another formula: Nanxing, Shanzha, Cangzhu 2 liang each; Baizhi, Banxia, Zhishi, Shenqu 1 liang each; Haizao (Sargassum), Kunbu (Laminariae Thallus) 0.5 liang each; Xuanmingfen (Natrii Sulfas), Wuzhuyu 2 qian each. Powder, wine paste pills. Another formula for Mu Shen (Wood Kidney/Painless Hernia): Nanxing, Banxia, Huangbai (Phellodendri Cortex, wine-washed), Cangzhu (salt-fried), Zhishi, Shanzha, Baizhi, Shenqu (fried), Huashi (Kaolinitum, fried), Zhuyu, Kunbu. Wine paste pills, salt water on empty stomach. For distension, use Xiangfu (Cyperi Rhizoma) powder, decoct with seaweed in wine, chew seaweed, drink wine with powder. Chu Ye (Broussonetiae Folium, male/dry) powder, wine paste pills, salt liquor on empty stomach. Jiegu Gege Haiwan (Shell Pill). Qi pain is easy to treat: Lihex San, Sansheng Huixiang Wan, Xianbao Wan, Dihuang Gaozi Wan, Anshixiang Wan, Nianzhu Wan. Select as appropriate. Scrotal swelling with bowel/bladder obstruction: Sanbai San. Early unilateral descent: Chanshunjia (Manis Squama) and Huixiang powder, wine wash, dry compress externally. External: Mudli (Ostreae Concha, calcined), Liangjiang (Alpinae Rhizoma) equal parts, saliva paste applied to larger side; burning pain subsides quickly. Danxi treated a man: post-drinking water/fruit, unilateral kidney enlarged, croaking sound/pain. Fried Zhishi 1 liang, salt-fried Huixiang, fried Shanzhi, 3 qian each, grind/decoct, take Baohe Wan. Another case: Bladder Qi sinking with croaking sound, roasted orange seeds 10, peach kernels 20, radish juice, take Baohe Wan. Left testicular swelling/pain from dietary damp-heat transforming to heat: Tangerine seeds 5, peach kernels 7, grind, decoct in flowing water, take Baohe Wan. Mu Shen (Wood Kidney): Steam/wash with Loquat leaf, Wild Perilla leaf, Xiancao (Acanthopanacis Senticosi Caulis/Radix - *Text says Cang'er Ye Xanthocarpium Leaf*), Grape leaf strong decoction. Realgar 1 liang, Alum 2 liang, Raw Licorice 0.5 liang, water 5 sheng, boil and wash. Jingjie (Schizonepetae Spica) 1 liang, Pomiao 2 liang, coarse powder, radish/scallion decoction pour over. Rhubarb powder mixed with vinegar, apply, change when dry. Verbena crushed and applied. Turnip root crushed and applied. Classics: Yangming ruling Heaven, Dryness prevails, men have hernia, women lower abdominal pain. Yangming Victory, external hernia, Dryness attacks deficient Liver. Treatment: Tonify Liver, drain Dryness-Metal. Jueyin Hernia, women lower abdominal swelling. Jueyin corresponds to Chen month (3rd lunar month), Yin within Yang. Evil in middle causes hernia/lower abdominal swelling. Long Hernia (Urinary retention) skin distension: Yin excess, vessel obstruction. Three Yang disease: chills/fever, lower abscesses, flaccidity/cold limbs, transmitting to Hernia. Dongyuan cites *Yinyang Bielun*: Three Yang disease... transmits to Hernia. Heat outside/Cold inside causes pendulous scrotum (Summer). Cold outside/Heat inside causes retracted testicles (Winter). Foot Taiyang Bladder channel meets Hand Taiyang Small Intestine, descends to Foot Jueyin Liver. Liver channel cannot extend; Ren Mai joins Jueyin. Reversal like a great river causes Yang Qi to sink, Wind-Cold-Damp-Heat exit scrotum, causing bilateral testicular swelling (Hernia), extreme cases become [Severe Hernia]. Jueyin and Taiyang Cold Water channels meet at genitals. Shanghan scholars say Jueyin disease causes irritability and retraction, treat urgently with Dachengqi Tang (Major Order the Qi Decoction) to drain Heat. *Ling Shu* says Jueyin channel cold causes tendon contraction and retraction (Cold). Previous theory said retraction is Heat; this says Cold. This theory says retraction/descending hernia/Hong Kong foot is Cold, Wind-Damp descending is Cold. How differs from previous? Answer: Healthy person: Summer heat causes pendulous scrotum; Winter cold causes retraction. This differs from previous three theories. Are they contradictory? Answer: Shanghan retraction is Internal Heat, treat with Dachengqi Tang. Tendon theory retraction is External Cold but Internal Heat (same as Shanghan). Thus, healthy person proof: Winter Yang inside/Yin outside -> Cold outside makes skin tight -> retraction. Summer Yin inside/Yang outside -> Heat outside makes skin loose -> pendulous. This is Hernia sign. Three theories differ in logic but share principle. Physicians must examine carefully. These three theories have specific focuses; combining them clarifies Pulse/Symptom Yin-Yang/Cold-Heat/Deficiency-Excess differentiation. *Neijing* has four acupuncture/moxa methods for Hernia: 1. Pip Shi (Knife stone) to drain fluid from scrotum. Classics: Waist/spine are major joints; legs are tubes for movement; penis/scrotum are mechanisms of essence/fluid. Irregular diet/emotions cause fluid overflow to testicles, blood flow blocked, long-term immobility. Fluid accumulates, neither rising nor falling. Knife stone removes it; shape cannot be hidden, named "Qu Zhao" (Remove Claws). Modern people still know this. Large scrotum holds liters of turbid fluid, proving ancient origin. 2. Treat Liver. Classics: Foot Jueyin moving disease causes men's hernia, women's lower abdominal swelling. On Foot Jueyin Liver channel, assess Excess/Deficiency/Heat/Cold/Collapse, apply tonify/draining/retention/speed/moxa. 3. Treat Liver Collateral. Classics: Foot Jueyin branch named Ligou (蠡沟), 5 cun above medial malleolus, branches to Shaoyang, ascends to testicle, knots at penis. Qi reversal causes testicular swelling/sudden hernia; treat the branch. Needle Ligou (LR-5) 5 cun above medial malleolus, posterior to tibia near flesh. 4. Treat Foot Yangming Tendon. Classics: Foot Yangming tendons gather at genitalia, ascend to abdomen. Disease: tendon twitching, thigh anterior swelling, hernia, abdominal tendon tension. Treat with burning needle (fire needle) puncture, repeat until sensation changes, pain point as acupoint. Needle twitching/pain site with fire needle.

[Fox Hernia]: Enters abdomen when lying, exits abdomen when standing, deviates into scrotum. Zhongjing formula: Yin Fox Hernia Qi varying in size, moving up and down, treated with Zhizhu San (Spider Powder). *Neijing* acupuncture/moxa for Fox Hernia treats only Foot Jueyin channel. Classics: Liver Foot Jueyin channel diseases include Fox Hernia. Treat based on channel Excess/Deficiency/Heat/Cold/Collapse. Ear depression indicates Kidney descent; Kidney descent causes lumbar/sacral pain, inability to bend/extend, constituting Fox Hernia.

General Treatment: Regardless of syndrome, use Shengliao Wuji San (Raw Five Accumulations Powder), 1 liang per dose, add Salt-fried Wuzhuyu, Huixiang 1 qian each, Shengjiang 3 slices, Congbai (Scallion White) 5 cun. Decoct, take hot on empty stomach. If ineffective, severe stabbing pain, retraction, cold limbs: use Xiangfu (Cyperi Rhizoma), salt fried hot, wrap in silk, moxa lower abdomen. If bowels not open: Wuling San + Gui (Cinnamon Twig), take Qingmuxiang Wan (Green Wood-Aromatic Pill). Initial onset headache/fever or chills/high fever: Can Su Yin (Ginseng and Perilla Decoction) + Muxiang. Upward counterflow, heart discomfort/pain: Fresh garlic juice mixed with Wuling San pills, Huixiang decoction wash. Kidney Qi moves, Heart Qi activates, upper/lower pain: Yigong San swallow Zhuyu Neixiao Wan (Evodia Internal Dissolving Pill). Or treat lower first; lower pain settles, upper pain settles. Divine Formula for Hernia Qi rushing up, blocking chest/heart, feeling like dying, cold limbs: 2-3 doses cure root. Sulfur melted in fire, dropped in water to detoxify, ground fine; Litchi seed sliced fried yellow, Chenpi (Citri Reticulatae Pericarpium) equal parts. Powder, rice pills, paulownia seed size. Take 14-15 pills with warm wine, pain stops immediately. If patient cannot bear pain, give only 6 pills, do not exceed. Food accumulation and Blood Stasis pain: Guide accumulation, move blood to cure. (Refer to Food Injury and Blood Stasis chapters.)

Diagnosis: Cun Kou wiry/tight indicates Cold Hernia. Wiry means Wei Qi obstruction, leading to aversion to cold. Tight means loss of appetite. Cun Kou slow/relaxed: Slow is Cold, Relaxed is Qi. Cold-Qi interplay causes twisting pain. Deep/Tight/Hollow/Large indicates Deficiency. Wiry/Urgent/Pulsating all indicate Hernia; location determines affected Zang organ. Heart pulse slightly slippery = Heart Hernia. Liver pulse slippery = [Hernia]. Kidney pulse slippery = Long Hernia (Urinary retention). Large/Urgent/Deep = Kidney Hernia. Liver pulse Large/Urgent/Deep = Liver Hernia. Heart pulse Slippery/Urgent = Heart Hernia. Lung pulse Deep/Pulsating = Lung Hernia. Spleen pulse Tight = Spleen Hernia. Cun wiry/tight, interplay = Cold Hernia. Zu Yang (Dorsalis Pedis) Empty/Slow = Cold Hernia. Liver pulse very slippery = [Hernia]. Kidney/Liver pulse very slippery = Long Hernia.